Tretinoin / Benzoyl Peroxide (Twyneo®)

Tretinoin / Benzoyl peroxide is a combination medication that is available as a prescription topical treatment for acne. It is usually applied once a day.

• Available forms:
  
  
  • Topical treatment:
    
    
    • Cream:
      Available as prescription
      Generic not available (US)
      
    • Brand names (US):
      • Twyneo®

• Available in this dose: (tretinoin / benzoyl peroxide)
  
  
  • Cream: 0.1% tretinoin / 3% benzoyl peroxide
• Who is it for?
  
  
  • Gender:
    • Males and females
  • Severity of acne:
    • All degrees
  • Age: (US labelling)
    • 0.1% Tretinoin / 3% Benzoyl Peroxide (Twyneo®): children 9 years and older, adolescents, and adults

How to use it:

Tretinoin / Benzoyl peroxide is topically applied once a day to all acne-affected areas of the skin, and not just on individual pimples themselves. Tretinoin / Benzoyl peroxide should not be applied on abraded or broken skin or on skin affected by eczema, sun- or windburn. Wait until the skin is healed to apply tretinoin / benzoyl peroxide. Tretinoin / Benzoyl peroxide should not be applied on mucous membranes, eyes, or lips. If tretinoin / benzoyl peroxide gets into your eyes, wash them with a generous amount of water and call your physician. When tretinoin / benzoyl peroxide gets into the eyes, the eyes may get irritated, swollen, or infected. 

Follow the instructions on your prescription carefully and apply tretinoin / benzoyl peroxide exactly as prescribed by your physician. Do not change the amount or the frequency of the medication. If you have any questions about the medication or the prescription, ask your physician or pharmacist. 

The dosing for children and adolescents is the same as the dosing for adults.

Applying more medication than prescribed or applying the medication more frequently than prescribed will not make tretinoin / benzoyl peroxide work faster. However, it may increase the risk of side effects such as skin irritation, redness, or peeling of the skin. 

Before applying tretinoin / benzoyl peroxide, wash your hands with soap and water and wash acne-prone areas with water and a mild cleanser. Do not scrub the skin. Rinse and pat the skin dry gently with a soft towel. Then, apply tretinoin / benzoyl peroxide to acne-prone areas. 

You may experience dry skin or skin irritation when you use tretinoin / benzoyl peroxide. These symptoms are most likely to occur during the first month of treatment and usually lessen as you continue to use it. The application of a moisturizer may help relieve dry skin and irritation. Sometimes, a decrease in the frequency of use or discontinuation of the treatment may be recommended. 

• Cream:
  • Apply a thin layer (pea-size amount) of tretinoin / benzoyl peroxide on clean and dry, acne-affected areas of the skin. Use your fingers to very gently apply the medication until it is absorbed into the skin.

Be aware of:

• Before using tretinoin / benzoyl peroxide, let your physician or pharmacist know if you are allergic to tretinoin, benzoyl peroxide, or any of the other ingredients in the treatment. If you are allergic to other retinoids, you may or may not be allergic to tretinoin.
• Before using tretinoin / benzoyl peroxide, tell your physician if you currently suffer from or have ever suffered from eczema or have a history of cancer. Your physician may advise you not to use tretinoin / benzoyl peroxide.
• Tretinoin / Benzoyl peroxide may make your skin more sensitive to extreme weather, such as intense cold or wind, or direct sunlight. Avoid unnecessary or prolonged exposure to real and artificial sunlight (including tanning beds and sunlamps), and cold temperatures. Use sunscreen with an SPF of at least 15, especially if you tend to get sunburned easily. Wear sunglasses and protective clothing. 
• Avoid using hot wax or other hair removal products while using tretinoin / benzoyl peroxide cream, as these can worsen skin dryness and irritation.
• Avoid the use of other potentially irritating topical skin products while using tretinoin / benzoyl peroxide, such as medicated or abrasive soaps or skin cleansers, soaps and cosmetics with strong skin-drying effects and products with a high percentage of alcohol, astringents, spices or limes, unless instructed by your physician. 
• Tretinoin / Benzoyl peroxide may cause bleaching of hair or colored fabric. 
• If you are also using sulfone products like dapsone or sodium sulfacetamide, using tretinoin / benzoyl peroxide at the same time may cause your skin or hair to temporarily turn yellow/orange. Applying the medications at separate times of day can help you avoid this.
• Only use tretinoin / benzoyl peroxide to treat the condition it was prescribed for. Do not use it for the treatment of any other skin condition you might suffer from, without consulting your physician first.
• If you are using tretinoin / benzoyl peroxide and are pregnant or are planning to become pregnant, talk to your physician about using tretinoin / benzoyl peroxide during pregnancy.
• If you are using tretinoin / benzoyl peroxide and are breastfeeding, talk to your physician about using tretinoin / benzoyl peroxide during this period.
• Do not share your medication with anyone else. 
• You can continue your regular diet unless your physician tells you otherwise.

Drug interactions:

Inform your physician or pharmacist about all the prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan on taking before starting tretinoin / benzoyl peroxide. Also inform your physician or pharmacist of the skin products you use including soaps, cleansers, moisturizers, and cosmetics. 

Do not swallow

If tretinoin / benzoyl peroxide is swallowed, contact an emergency facility or call the American Association of Poison Control Centers at 1 (800) 222-1222 (available 24/7).

If immediate assistance is necessary because the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, call 911.

Information can also be found online at https://www.poisonhelp.org/help

What if I miss a dose?

As soon as you recall that you have missed a dose, apply the missed dose. However, skip the missed application if it is almost time for your next application and continue with your prescribed dosing schedule. Do not increase the quantity or frequency of application to make up for the missed dose. 

Storage:

Store your medication in the container that the pharmacist provided and keep it out of reach and out of sight of children. Many containers can be opened by children. Keep the container tightly closed. Always lock safety caps and immediately place the medication in a safe location that is up and away from the sight of young children, to prevent poisoning (www.upandaway.org).

Store the medication at room temperature. Keep the medication away from excessive heat and moisture – do not store in the bathroom. Do not freeze tretinoin / benzoyl peroxide.

Disposal:

Do not keep outdated medication and medication that you no longer use. Unneeded medications should be disposed of in a way that pets, children, and other people cannot consume them. Do not flush the medication down the toilet. Contact your pharmacist to learn about the availability of a medicine take-back program in your neighborhood, or get in touch with your local garbage/recycling department to ensure safe disposal. If you do not have access to a take-back program, you can find more information on safe disposal of medication on the FDA website: (https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm)